Octenisan md Nasengel, 6 ml

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Sousa RJG, Barreira PMB, Leite PTS, Santos ACM, Ramos MHSS, Oliveira AF. Preoperative Staphylococcus aureus screening/decolonization protocol before total joint arthroplasty-results of a small prospective randomized trial. J Arthroplasty. 2016;31:234–9. Octenidine (Octenisan®) nasal gel is applied twice daily for 5 days or until screening results are confirmed, whichever is sooner Leigh DA, Joy G. Treatment of familial staphylococcal infection-comparison of mupirocin nasal ointment and chiorhexidine/neomycin (naseptin) cream in eradication of nasal carriage. J Antimicrob Chemother. 1993;31:909–17. Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI. Methods Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: Clinical implications and potential alternatives for the eradication of mrsa. J Antimicrob Chemother. 2015;70:2681–92.

Neomycin is an aminoglycoside antibiotic active against both gram-positive and gram-negative bacteria. There is limited research into the efficacy of neomycin ointment for nasal MSSA decolonisation. Leigh et al. showed neomycin achieved nasal decolonisation in 61% of cases compared to 95% with mupirocin at 8 days after treatment [ 18]. Resistance to neomycin has been reported as high as 42% in a study from Brazil, the authors note this is likely due to its popular use without prescription in the country [ 19]. There is no evidence that topical anti-infective nasal preparations have any therapeutic value in rhinitis or sinusitis.Do not use the octenisan® md nasal gel without medical supervision for longer than 2 weeks without interruption. The topical antibiotic mupirocin is the only treatment that currently has good study data. The majority of existing research focuses on decolonisation as a method to reduce SSI and nosocomial infections i.e. an active treatment is compared to a non-active control. There are very few studies comparing different treatment options. In the UK, National Institute for Clinical Excellence (NICE) guidance states mupirocin should be considered whenever MSSA is a likely cause of SSI [ 26]. This is the first clinical study assessing the effectiveness of topical intranasal octenidine and universal antiseptic bathing with chlorhexidine or octenidine on the reduction of MRSA prevalence in extended care facilities. The reduction in the prevalence of MRSA colonisation by 43–58% suggest the effectiveness of intranasal octenidine on decolonisation of MRSA carriage and nosocomial transmission in extended care facilities. The decline in MRSA colonisation of 58% in Hospital A from 2015 (chlorhexidine bathing) to 2016 (chlorhexidine bathing and intranasal octenidine) was similar to the 60% reduction in multidrug-resistant organisms reported in another study involving universal chlorhexidine bathing and intranasal povidone-iodine [ 11]. Nouwen JL, Ott A, Kluytmans-Vandenbergh MFQ, Boelens HAM, Hofman A, van Belkum A, et al. Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule.” Clin Infect Dis. 2004;39:806–11.

These are medicines that require significant monitoring. The decision to treat with an AMBER medicine should be made by specialists only. If a Shared Care Protocol exists then this must be followed. Amber 1 medicines require more monitoring by the GP than Amber 2 medicines. For moistening and decontamination of nasal vestibules and supportive wound treatment of lesions in the nasal epithelium Octenidine HCl is a topical antiseptic with activity against both gram-positive and gram-negative bacteria. As an antiseptic nasal gel octenidine can be supplied by the surgical pre-assessment team without prescription, streamlining the process, and reducing cost. Although it has less potential for inducing resistance than mupirocin [ 16], there is some reduction in bacterial susceptibility to octenidine HCl emerging [ 17]. These are medicines that require significant monitoring. and the decision to treat with an AMBER medicine should be made by specialists only.Neomycin is an aminoglycoside antibiotic active against both gram-positive and gram-negative bacteria. There is limited research into the efficacy of neomycin ointment for nasal MSSA decolonisation. Leigh et al. showed neomycin achieved nasal decolonisation in 61% of cases compared to 95% with mupirocin at 8days after treatment [ 18]. Resistance to neomycin has been reported as high as 42% in a study from Brazil, the authors note this is likely due to its popular use without prescription in the country [ 19].

Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871–7. Dadashi M, Hajikhani B, Darban-Sarokhalil D, van Belkum A, Goudarzi M. Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. J Glob Antimicrob Resist. 2020;20:238–47.

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Van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev. 2008;2:129. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common healthcare-associated drug-resistant organisms in the world, particularly in Asia [ 1]. Decolonisation of MRSA carriage has been found to be effective in preventing nosocomial transmission of MRSA in various healthcare settings including intensive care units (ICUs), hospital wards and nursing homes [ 2]. MRSA decolonisation guidelines have included whole-body bathing with an antiseptic and topical intranasal treatment with mupirocin [ 3]. Intranasal topical mupirocin has been shown to be effective in eradicating nasal MRSA carriage, but the emergence of mupirocin resistance has been associated with decolonisation failure [ 3]. Antiseptic agents including povidone-iodine and octenidine dihydrochloride have been used as alternatives for nasal decolonisation. Koburger T, Hübner NO, Braun M, Siebert J, Kramer A. Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010;65:1712–9. Primary outcome was decolonisation efficacy, measured by MSSA positive culture on the day of surgery. The secondary outcome was MSSA PJI.

Bessa GR, Machado DC, Weber MB, D’Azevedo PA, Quinto VP, Lipnharski C, et al. Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis. An Bras Dermatol. 2016;91:604–9.

Specialist initiated - These are medicines that require little or no monitoring by the GP, but should only be prescribed in general practice after they have been initiated following specialist referral. If a Shared Care Protocol exists then this must be followed. Amber 1 medicines require more monitoring by the GP than Amber 2 medicines. Joint effects* (simultaneous influences) of Hospitals A, B and C, and years 2015 and 2016, respectively, on the prevalence of MRSA colonisation *adjusted for age, gender, Charlson's comorbidity index >5, prior MRSA carriage in preceding 12 months, prior antibiotics exposure in preceding 12 months, length of hospital stay prior to MRSA screening. **Prevalence of MRSA colonization in Hospital C in 2015 served as the reference. Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used. Results Do not use in combination with cleansing soaps, ointments, oils, enzymes or similar, as this may affect the preservation.